Telomere length determined by the fluorescence in situ hybridisation distinguishes malignant and benign cells in cytological specimens.

BACKGROUND: Telomeres are tandem repeats of TTAGGG at the end of eukaryotic chromosomes that play a key role in preventing chromosomal instability. The aim of the present study is to determine telomere length using fluorescence in situ hybridisation (FISH) on cytological specimens. METHODS: Aspiration samples (n = 41) were smeared on glass slides and used for FISH. RESULTS: Telomere signal intensity was significantly lower in positive cases (cases with malignancy, n = 25) as compared to negative cases (cases without malignancy, n = 16), and the same was observed for centromere intensity. The difference in DAPI intensity was not statistically significant. The ratio of telomere to centromere intensity did not show a significant difference between positive and negative cases. There was no statistical difference in the signal intensities of aspiration samples from ascites or pleural effusion (n = 23) and endoscopic ultrasound-guided FNA samples from the pancreas (n = 18). CONCLUSIONS: The present study revealed that telomere length can be used as an indicator to distinguish malignant and benign cells in cytological specimens. This novel approach may help improve diagnosis for cancer patients.

Differentiation of exudate from transudate ascites by Doppler sonography.

BACKGROUND: We investigated whether the addition of Doppler sonography (US) increases the diagnostic confidence of US for estimating the nature of ascites. METHODS: Of the 127 cases reviewed in this study, there were 42 cases of transudate and 85 of exudate ascites. We reviewed the US, power Doppler, and pulsed Doppler images of these cases. RESULTS: With US, the transudate ascites was imaged as free of echo in 38 of 42 cases (90.5%). The exudate ascites was imaged as free of echo in 22 of 85 cases (25.9%) and with internal echo spots in 63 of 85 cases (74.1%). With Doppler US, we obtained distinct pulsed signals from the transudate ascites in only two of 36 cases (5.6%). In contrast, we obtained distinct Doppler signals from the exudate ascites in 66 of 79 cases (83.5%). Those 66 cases included 16 of the 22 cases with echo-free ascites. CONCLUSION: The presence or absence of echo spots within the ascites helped differentiate transudate from exudate ascites, as reported in the literature. However, the addition of Doppler US contributed to the differentiation of echo-free exudate (Doppler signals present) from echo-free transudate (Doppler signals absent) ascites.

Segmental chronic cholecystitis: sonographic findings and clinical manifestations.

BACKGROUND: In chronic cholecystitis, the gallbladder (GB) wall is usually evenly involved, whereas marked segmental thickening of the GB wall (segmental cholecystitis) seldom is reported. We wanted to define its clinical manifestations and sonographic (US) findings. METHODS: We reviewed the clinical and US data of 13 cases and compared these results with those of 30 patients with chronic cholecystitis with evenly thickened GB walls (usual-cholecystitis group). RESULTS: (a) All cases of segmental cholecystitis showed the portion distal to the kinking to be markedly thickened. (b) The thickened portion corresponded to the fundus in three cases, the body and fundus in seven cases, and the fundus, body, and infundibulum in three cases; and the thickened distal portion contained many stones in 11 cases. (c) There was no difference in the maximal diameters of the GB walls between the segmental-cholecystitis group and the usual-cholecystitis group. However, there was a significant difference in the minimal diameters of the GB walls between groups. CONCLUSION: Knowledge of the US findings and clinical presentations of segmental cholecystitis can help in the development of appropriate diagnostic and therapeutic strategies.

Duodenal carcinoma: sonographic findings.

BACKGROUND: Duodenal carcinoma is a relatively rare tumor and its sonographic (US) findings have rarely been reported. METHODS: We reviewed the clinical data and US results of 15 patients with histologically proven duodenal carcinoma to pinpoint the contribution of US to the diagnosis. RESULTS: US was useful for not only detecting the duodenal carcinoma (13 of 15, 86.7%), which altered the endoscopic procedure in nine patients, but also for evaluating vascular involvement (marked portal invasion in four cases and inferior vena cava invasion in two cases). Four of the eight carcinomas arising from the second or third portion showed this vascular invasion. CONCLUSION: After reviewing the clinical data and US results of 15 cases of duodenal carcinoma, we found that US was useful for detecting duodenal carcinoma and determining vascular invasion. Thus, US contributed significantly to alter the endoscopic procedure and patient management.

Liver tumors in fatty liver: difficulty in ultrasonographic interpretation.

BACKGROUND: Fatty liver and liver tumors are very frequent diseases. Sonography (US) currently is the initial diagnostic tool for hepatic exploration. However, there is a marked paucity of US findings of tumors in fatty liver. METHODS: We studied the US findings of 41 lesions (31 patients) with this combination, with special attention paid to internal echoes, marginal echoes, and especially the mode of back echoes, and compared them with the US results of 64 lesions (38 patients) without fatty liver. RESULTS: Comparing the group having liver tumor without fatty liver with the group having liver tumor with fatty liver showed that (a) the number of hypoechoic lesions increased (29 of 41, 70.7%, vs. 16 of 64, 25.0.%), (2) the tumor margin appeared indistinct (32 of 41, 78.0%, vs. nine of 64, 14.1%), and (c) the lesions showing posterior echo enhancement increased (34 of 41, 82.9%, vs. eight of 64, 12.5%). CONCLUSION: Liver tumors in fatty liver are expected to show unusual patterns on US, so we should consider this difficulty when interpreting these US findings and we should not make a conclusion without including other imaging modalities.

Peripheral bone metastasis from hepatocellular carcinoma: sonographic findings.

BACKGROUND AND METHODS: We reviewed medical and radiologic records of five patients with bone metastasis from hepatocellular carcinoma (HCC) to evaluate the role of sonography (US) in the diagnosis of this bone metastasis. RESULTS: The metastatic lesions were clearly visualized by US as expansive, homogeneous, soft tissue masses with bony destruction, and color Doppler US showed fine vessels within the lesions. After treatment, US showed a decrease in tumor size with an increase in echogenicity and a decrease in blood flow. Hepatic US at the time of bone metastasis showed a portal tumor thrombus in all cases. CONCLUSION: When US detects a portal venous tumor thrombus in HCC patients, attention should be directed not only to the liver but also to bone to improve patient care. US is useful not only in detecting the metastatic lesion but also in evaluating the treatment effect.

Macronodular deformity of the spleen.

BACKGROUND AND METHODS: Macronodular splenic deformity without a focal lesion has rarely been reported. We present three such cases and discuss the possible pathomechanism. RESULTS: There was one case of macronodular deformity of unknown cause. In this case, the liver was elongated anteriorly over the dome of the spleen, and the markedly deformed spleen mimicked a round lesion in the left lobe of the liver. Color Doppler ultrasonography showed the major intra- and perisplenic vessels to be patent. There were two cases of macronodular deformity associated with extended portal thrombosis. In both cases, portal thrombosis extended throughout the intrahepatic and extrahepatic portal systems, and this portal flow disturbance was presumed to be the cause of the splenic deformity. CONCLUSION: Although very rare, thrombosis should be sought throughout the portal system when ultrasonography shows a markedly deformed spleen. Marked splenic deformity, especially in cases with an elongated liver, may mimic a liver tumor. A good understanding of its sonographic appearance may help sonographers prevent a hazardous misdiagnosis.

Pancreatic metastasis: sonographic findings.

BACKGROUND: Pancreatic metastasis is a relatively rare pathologic condition. Its ultrasound (US) findings have been infrequently reported, and there has been no previous report describing its color Doppler findings. METHODS: We reviewed the US findings of 13 such cases. RESULTS: The pancreatic metastasis consisted of a single hypoechoic nodule in four cases and multiple hypoechoic nodules in nine cases. US showed a slight dilatation of the main pancreatic duct in two cases of pancreatitis, and a marked biliary dilatation in one case of jaundice. The US results prompted introduction of appropriate treatment in these cases. Color Doppler US was useful for confirming the absence of flow abnormalities in the arterial and portal systems around the pancreas. In a patients with renal carcinoma metastasis, it showed many fine blood flow signals in the metastatic lesions. CONCLUSION: The role of US in the diagnosis of pancreatic metastasis consists of associated complications such as biliary dilatation or pancreatitis and detection of isolated lesions. Additional information provided by color Doppler US may increase diagnostic confidence.

Pancreatic uncinate carcinoma: sonographic findings.

BACKGROUND: Pancreatic carcinoma arising from the uncinate process (pancreatic uncinate carcinoma) is relatively rare. We wished to define its clinical manifestations and sonographic findings. METHODS: Clinical and sonographic data of eight cases were reviewed. RESULTS: The common bile duct and the pancreatic duct were not dilated until a very late stage. The lesion mimicked a mesenteric tumor in two cases. The superior mesenteric vessels were compressed anteriorly. Computed tomography was useful, not only for confirming the pancreatic uncinate origin of the lesion but also for determining precisely the mode of mesenteric vascular involvement. CONCLUSION: Knowledge of these unusual sonographic findings can determine the diagnostic strategy in pancreatic uncinate carcinoma.

An efficient synthesis of (±)-narwedine and (±)-galanthamine by an improved phenolic oxidative coupling.

Old problems, new ideas! The biomimetic phenol coupling of norbelladine derivatives such as 1 (Bn = benzyl) to form galanthamine (2), a drug used in the treatment of Alzheimer's disease, has been greatly improved by the use of the hypervalent-iodine oxidation reagent phenyliodine(III) bis(trifluoroacetate) (PIFA).

A catalytic asymmetric strecker-type reaction promoted by Lewis acid-Lewis base bifunctional catalyst.

A general asymmetric Strecker-type reaction is reported, catalyzed by the Lewis acid-Lewis base bifunctional catalyst 1. The reaction of trimethylsilyl cyanide (TMSCN) with various fluorenyl imines, including n-aldimines and alpha,beta-unsaturated imines, proceeds with good to excellent enantioselectivities in the presence of a catalytic amount of phenol as additive (20 mol%) (catalytic system 1). The products were successfully converted to the corresponding amino acid derivatives in high yields without loss of enantiomeric purity. Furthermore, hydrogenation or dihydroxylation of the products from alpha,beta-unsaturated imines afforded saturated or functionalized aminonitriles also without loss of enantiomeric purity. The absolute configuration of the products and a control experiment using catalyst 2 supported the proposed dual activation of the imine and TMSCN by the Lewis acid (Al) and the Lewis base moiety (phosphine oxide) of 1. From the mechanistic studies including kinetic and NMR experiments of the catalytic species, the role of PhOH seems to be a proton source to protonate the anionic nitrogen of the intermediate. Specifically, we have found that TMSCN is more reactive than HCN in this catalytic system, probably due to the activation ability of the phosphine oxide moiety of 1 toward TMSCN. This fact prompted us to develop the novel catalytic system 2, consisting of 1 (9 mol%), TMSCN (20 mol%) and HCN (1.2 mol eq). This new system afforded comparable results with obtained by system 1 (1 (9 mol%)-TMSCN (2 mol eq)-PhOH (20 mol%)).

Macronodular hepatic deformity on normal liver.

BACKGROUND AND METHODS: Macronodular hepatic deformity on normal liver is very rare. We present nine such cases and try to define the characteristic clinical and ultrasound (US) findings. RESULTS: In the left lobe, the lateral segment was replaced by multiple nodules and the medial segment was very atrophied and irregularly shaped. Compared with the left lobe, the right lobe showed very few abnormalities except for segment 6, which showed a macronodular deformity. These nodules, regardless of diameter or lobe, showed a relatively homogeneous internal structure and were isoechoic relative to the surrounding hepatic parenchyma. These multinodular changes on US corresponded to multiple regenerative nodules identified at laparoscopic evaluation. On color Doppler US and angiography, the major intrahepatic vessels were patent in all cases. CONCLUSION: Although relatively rare, the macronodular hepatic deformity on normal liver collected in our series showed a characteristic appearance by US. A good understanding of its characteristics may help sonographers in differentiating it from other, more common hepatic deformities.

Liver tumors in children and young patients: sonographic and color Doppler findings.

BACKGROUND: Liver tumors are a relatively rare pathologic condition in children and young patients. The aim of the present study was to categorize the sonographic (US) and color Doppler results of liver tumors in these patients. METHODS: We retrospectively reviewed the US findings of 23 such cases: malignant tumor (13 cases)-hepatoblastoma (four cases), hepatocellular carcinoma (HCC; four cases), and hepatic metastasis (five cases); benign tumor (10 cases)-hepatocellular adenoma (four cases), focal nodular hyperplasia (two cases), mesenchymal hamartoma (two cases), cystadenoma (one case), and hemangioendothelioma (one case). RESULTS: There was no specific US findings for each tumor type. HCC usually developed on a normal liver and was imaged as multiple nodules. Color Doppler US helped in differentiating multiple metastatic nodules (hypovascular) from multiple HCC nodules (hypervascular). Presence of intratumoral cystic areas was usually suggestive of benign tumors. Follow-up US was useful for detecting small nodules in high-risk groups (congenital biliary atresia, glycogen storage disease). Color Doppler US helped in diagnosing portal thrombus or intratumoral shunt. CONCLUSION: Although there were no highly specific findings, US and color Doppler results contributed, to a certain degree, to the diagnosis of liver tumors in children and young adults by showing intratumoral cystic areas or vascularity.

Abdominal involvement in neurofibromatosis 1: sonographic findings.

BACKGROUND: Neurofibromatosis 1 (NF1) has been studied from many viewpoints, but its abdominal involvement has rarely been reported. Sonography (US) is now the initial diagnostic tool for abdominal exploration, which prompted us to determine the clinical manifestations and US findings of abdominal involvement in NF1. METHODS: We analyzed the US findings and clinical data of eight NF1 cases with abdominal involvement. RESULTS: Abdominal involvement included neurofibromatous tumor growth in the liver, mesentery, and retroperitoneum, in addition to mesenteric leiomyomatosis and gastric carcinoma. Color Doppler US was useful not only in detecting blood flows in the lesions but also in preventing hazardous vascular injury during tumor biopsy. CONCLUSION: A better understanding of the clinical manifestations and US findings of abdominal involvement in NF1 translates into improved NF1 patient care.

Retroperitoneal liposarcoma: sonographic findings.

This study, based on sonographic (US) results of 10 cases with histologically proven retroperitoneal liposarcoma (eight well-differentiated and two pleomorphic types), shows that the presence of fine echogenic lines within the tumor is a useful sign for diagnosing a well-differentiated liposarcoma. Presence of numerous fine fibrous septa in the lipomatous tumor tissue is thought to be responsible for this interesting phenomenon. Of interest is the fact that the direction of these lines changed according to the probe format used: parallel horizontal lines when using a linear probe and concentric lines converging toward the probe when using a sector or curved linear probe. In contrast, pleomorphic liposarcoma does not show this US sign. Knowledge of these US findings is useful for the diagnosis of retroperitoneal liposarcoma.

Chilaiditi syndrome: sonographic findings.

BACKGROUND AND METHODS: Sonographic (US) findings of Chilaiditi syndrome have been rarely reported in the literature. We reviewed 18 cases of Chilaiditi syndrome to pinpoint its US pattern. RESULTS: (1) US showed gas echoes of different sizes superimposed over the entire liver in two cases and over the right hepatic lobe in six cases, leading to a high suspicion of Chilaiditi syndrome. (2) US showed a small gas echo in the hepatodiaphragmatic space, mimicking pneumoperitoneum in eight cases. In this instance, altering the patient's position allowed for confirmation of the lack of a change in the location of the gas echo, unlike cases of pneumoperitoneum. (3) The hepatic surface appeared as a hyperechoic mass in two cases. CONCLUSION: Knowledge of US patterns of Chilaiditi syndrome helps avoid confusion with pneumoperitoneum or hepatic masses.

Gallbladder carcinoma: color Doppler sonography.

This study, based on color Doppler and pulsed Doppler sonographic results of 13 cases with gallbladder carcinoma, eight cases of adenomyomatosis, and eight cases of tumefactive biliary sludge, shows that the presence or absence of blood flow signals helps in the differentiation between gallbladder carcinoma and tumefactive biliary sludge (84.6% sensitivity and 80.0% specificity). However, color Doppler sonography is still not fully capable of distinguishing all gallbladder carcinoma, and a further increase in Doppler sensitivity is mandatory for this purpose. Visualization of high-velocity blood flow within the lesion made gallbladder carcinoma more likely than benign tumor. In contrast, there was no difference in the resistive index between gallbladder carcinoma, adenomyomatosis, and normal subject groups, and the significance of the resistive index is a subject of future study.

Congenital absence of the horizontal portion of the left portal vein: ultrasound findings.

Congenital absence of the horizontal portion of the left portal vein is very rare and has been very reported sporadically. We present three such cases referred from other hospitals with a diagnosis of intrahepatic vascular anomaly. Color Doppler ultrasound not only confirmed the diagnosis but also allowed a quantitative measurement of blood flow in these cases. Although it is a very rare condition, knowledge of the ultrasound and color Doppler findings helps in establishing the diagnosis of this congenital anomaly.